Maria Badillo, MSN, RN, OCN^®, CCRP: Good afternoon, Diane. Happy Nurses Month. Before we start our questions, I would like to introduce Diane to the viewers. Diane is our Manager of Advanced Practice Providers and a clinical trials research nurse practitioner in the Department of Investigational Cancer Therapeutics here at MD Anderson in Houston, Texas. She has more than 34 years of nursing experience—wow, Diane—in general surgery, orthopedics, oncology, and early-phase clinical trials. Diane has authored several peer-reviewed articles and has presented nationally and internationally on oncology-related topics. Her research interests are to evaluate the role of advanced practice providers in patient outcomes and to evaluate strategies to improve the recruitment and retention of people of color in early-phase oncology clinical trials.

I'm so glad that you were able to join me today, Diane. For our topic today, I would like you to tell us, what is a diversified nursing work force for you?

Diane Barber, PhD, ANP-BC, AOCNP^®, FAANP, FAAN: Thank you. That's a great question, and I'd like to begin by pointing out that The Future of Nursing 2020-2030 identified that nurses should be instrumental in addressing health equity, as well as social determinants of health. The way to do that is to have a diversified nursing work force, and that can be a work force that is comprised of nurses from different ethnic/racial backgrounds, different ages, different sexual orientations, and even nurses who may have a disability.

Ms. Badillo: What do you think is the current status of diversity in nursing? Let's talk about at our institution.

Dr. Barber: At our institution, I think we're fortunate. We have over 4,700 nurses here, and I think MD Anderson is doing a great job of increasing diversity in the whole work force, especially nurses. I don't know the exact number as far as the percentage of racial breakdown, but if you look at overall in 2020, there was a National Nursing Workforce survey that came out. They found a rate of 6.7% Black or African American nurses; 7.2% Asian; 5.6% Hispanic, Latino, or Latina; and then 2.3% other races. Of those, also, 9.4% were male. If you look at the advanced practice role, there's a similar breakdown.

It has also been projected that in 2044, the U.S. population is going to be more than 50% minority. Today, if you look at statistics, only 20% of our nurses identify as a minority, and I'm sure MD Anderson is probably more representative of those numbers.

Ms. Badillo: I know you have talked to other nurses, and you've been part of the Oncology Nursing Society (ONS) and other organizations. From your discussions with them, do you think the way you see it at our institution is the same as at other hospitals?

Dr. Barber: Because MD Anderson makes a great effort in having a diversified workforce, I think we actually have more representation of ethnic or minority groups, to be honest. We also have those groups that actually address diversity, and we have a celebration each month of the different cultures. Without knowing the exact number, I would say our institution does a really good job of being representative of the population that we serve.

Ms. Badillo: How about other hospitals or other institutions? How do you see this compared with 34 years ago—are we more diversified now compared with 34 years ago?

Dr. Barber: Maria, that's a wonderful question. Even 24 years ago—as long as I've been working here at MD Anderson—I would say that out of the maybe 20 advanced practice providers (APPs) that we had at that time there, two of us who were people of color. If you go back 34 years ago when I first went into nursing, out of my class of 60 nursing students, I was one of two people of color. I would say that compared with the early 80s when I graduated, we have come a long way, because even then people of color were discouraged from becoming registered nurses. They actually kind of wanted us to become licensed vocational nurses, and that was because of the structural racism that was in place. They would encourage all of the people of color to go become a licensed vocational nurse versus a registered nurse. But I was one of those determined people who knew what I wanted, and I knew how to get it.

Ms. Badillo: Have you seen a lot more younger people now wanting to go into nursing compared with before?

Dr. Barber: Yes. Back 34 years ago, nursing was not considered a very high-profile profession. Most people thought nursing was more about bedside nursing, and they didn't think that we could do other things like being a nurse practitioner, a case manager, a manager, or even a health CEO or CFO. They saw us only as bedside nurses. A lot of people didn't like that because they didn't think it was glamorous; they didn't think it required a lot of education. It also wasn't popular at that time for men to go into nursing. People of color or people of different sexual orientation were not encouraged to consider nursing as a profession. Even in high school, it wasn't something that was promoted to the high school students.

Ms. Badillo: What do you think are the advantages—not only for MD Anderson, but overall—of having a diversified nursing workforce?

Dr. Barber: A health care facility that has a diversified nursing work force can help to address some of the conscious, as well as the unconscious, biases out there that lead to health disparities. I think that a diverse workforce can help with cultural competence. You have more of an understanding of different cultures and backgrounds. You can develop more innovative approaches to taking care of patients because you have other ideas, and they're not stagnant. They're not coming from one point of view; you have various points of view and experiences.

I also think, especially for patients of color or any other underserved or underrepresented population, that they see themselves if they see a nurse or physician who is similar to them. They feel this person probably has a better understanding of their culture; they may possibly speak their language; they may also trust them more, for instance, if they're introducing a clinical trial. Let's just say you're a person of color; the patient might say, "Well, this person is here. They're likely going to look out for me and will not use me as a guinea pig." So many people from underrepresented and underserved populations have unfortunately had bad experience in clinical research and at the hospital in general. Having a diverse work force, whether it's people of different races or people from different geographical areas, helps to show that we are trying to represent the people that we serve.

Ms. Badillo: That's correct. I agree with that because even with our clinical trials, we try to make sure that all types of minorities are being represented and that the opportunity is available to everybody. So, what do you think are the challenges of creating a diversified workforce?

Dr. Barber: I think one of the challenges is that some people of color, or those who are underrepresented or underserved, don't think of professions such as nursing or any other STEM profession as an opportunity for them. Sometimes it's because of the fact that they don't see people of color in the community hospital or community clinic where they may go. They don't see people that look like them, so they don't think that's an option for them, and they don't opt to join the nursing profession. That's a challenge because you have to get out there, approach people, and let them know this is a potential career opportunity.

Then you also have to recognize that some people don't have the bandwidth for access to the internet because of the environment they're in. They may have lack of funds, lack of mentors, or just a lack of resources. With all those challenges, as leaders, we have to come up with strategies to go where they are. When I say that, I mean we have to go to elementary schools, go to middle schools, and go to high schools. But it's best to start early, at the elementary school. Try to get people interested in the profession of nursing and other sciences, engineering, or math-type professions. But we have to go there and let them know, "Yeah, you too can do this."

Ms. Badillo: Do you know of any activities out there in the community that are available to spread about nursing opportunities?

Dr. Barber: Some of the professional nursing organizations have these types of activities. One of the professional nursing organizations that I belong to, the Fort Bend County Black Nurses Association that is next door to Houston, has a program where we actually go to some of the middle schools and do a pinning ceremony. We have people from various levels of nursing come and speak to those students, and we give them a cap. We can introduce nursing as a profession and just let them know, "You can do this. Despite the struggles we went through, we're here." We went through some of those struggles and told them, "You can do the same thing." So we do have things like that. The Houston ONS chapter has also done that before. They've gone to colleges or even high schools and introduced nursing as a profession too.

Ms. Badillo: Well, thank you so much, Diane. This is very, very important information for everybody to know about diversity in nursing. We need to especially encourage those people that don't have the access to know about nursing. This is a good profession, it's very fulfilling. As you know, you've enjoyed it very much, and you're still here working with us.

Dr. Barber: I love it.

Ms. Badillo: I love it too. This is my second career, and I love to be a nurse. Well, thank you so much, Diane, for your time, and happy Nurses Week.

Dr. Barber: The same to you, and happy Oncology Nursing Month.

About Ms. Badillo and Dr. Barber

Maria Badillo, MSN, RN, OCN^®, CCRP, is the Research Nurse Manager in the Lymphoma/Myeloma Department at The University of Texas MD Anderson Cancer Center. As a clinical trial manager, she develops research programs, manages protocol design and implementation, and coordinates patient participation in phase 1, 2, and 3 clinical trials. Ms. Badillo has been a speaker at several conferences, including the Oncology Nursing Society Congress and the Academy of Oncology Nurse and Patient Navigators Conference. Her research focuses on the development of novel therapeutics for patients with hematologic malignancies and the management of treatment-related adverse events.

Diane Barber, PhD, ANP-BC, AOCNP^®, FAANP, FAAN, is the Manager of Advanced Practice Providers and a clinical trials research nurse practitioner in the Department of Investigational Therapeutics at The University of Texas MD Anderson Cancer Center. Her research interests include the role of advanced practice providers in patient outcomes and strategies to improve the recruitment and retention of people of color in early-phase oncology clinical trials.

For More Information

Colby SL & Ortman JM (2015). Projections of the size and composition of the U.S. population: 2014 to 2060. Available at: https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.